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Spinal Cord Medicine

QUESTIONS

1. Regarding epidemiology, which of the following is the most common cause of spinal cord
injury (SCI)?
A) Falls
B) Violence
C) Motor vehicle accidents
D) Sports/recreation

2. What is the leading cause of death in chronic spinal cord injury (SCI)?
A) Heart disease
B) Respiratory disease
C) Genitourinary disease
D) Suicide

3. According to the International Standards for the Neurologic Classification of Spinal Cord
Injury (ISNCSCI), American Spinal Injury Association (ASIA) impairment score of B is
defined as?
A) Motor preservation greater than 3 levels below neurologic level and greater than half
the key muscles below the single neurologic level are less than 3
B) No motor function more than 3 levels below the motor level with sensory preservation
including sacral sparing
C) Motor preservation greater than 3 levels below the neurologic level and greater than half
the key muscles below the single neurologic level are graded greater than or equal to 3
D) Complete injury with no sensory or voluntary anal sphincter contraction

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4. A spinal cord injured patient was noted to have the following on physical examination:
motor preservation greater than 3 levels below the neurologic level and greater than half
the key muscles below the single neurologic level were less than 3. This would be classified
as an American Spinal Injury Association (ASIA) level:
A) ASIA A
B) ASIA B
C) ASIA C
D) ASIA D

5. Which of the following are key muscles tested in the scoring of the American Spinal Injury
Association (ASIA) exam?
A) C5-biceps, C7-triceps, T1-adductor digiti minimi, L5-quadriceps, S1-flexor hallucis
longus
B) C5-biceps, C6-flexor carpi ulnaris, C8-flexor digitorum profundus, L3-quadriceps,
L4-adductor magnus
C) C5-biceps, C8-flexor digitorum superficialis, L2-sartorius, L3-quadriceps, L5-biceps
femoris
D) C5-biceps, C8-flexor digitorum profundus, T1-abductor digiti minimi, L4-tibialis ante-
rior, S1-gastrocnemius

6. Which of the following is true regarding the zone of partial preservation (ZPP)?
A) Classified only in incomplete injuries
B) The most rostral segment below the assigned level that has sensory or motor function
C) The motor ZPP does not follow the sensory ZPP
D) All of the above

7. A hyperextension injury that occurs in low-velocity trauma that affects the upper (greater
than the lower) extremities is called?
A) Central cord syndrome
B) Brown-Séquard syndrome
C) Anterior cord syndrome
D) Cauda equina syndrome

8. What is the typical presentation of an individual with Brown-Séquard syndrome?

A) Ipsilateral motor loss at the level of the lesion and contralateral loss of position sense,
pain and temperature below the level of the lesion
B) Contralateral proprioceptive and motor loss at the level of the lesion with ipsilateral
loss of pain and temperature below the level of the lesion
C) Ipsilateral motor and proprioceptive loss at and below the level of the lesion with con-
tralateral loss of pain and temperature below the lesion
D) Contralateral motor loss at the level of the lesion, ipsilateral proprioceptive loss at the
level of the lesion, and contralateral loss of pain and temperature below the lesion

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9. Which of the following is true of the recommendations regarding prevention of upper

limb pain and injury in spinal cord injury (SCI) patients?
A) Minimize frequency of repetitive upper limb tasks
B) Minimize the force used to perform upper limb tasks
C) Minimize extreme positions of the joints
D) All of the above

10. What is the recommended duration for anticoagulant prophylaxis for an uncomplicated
complete spinal cord injury?
A) 6 weeks
B) 8 weeks
C) 12 weeks
D) Until discharge from rehabilitation

11. Vena cava filter placement should be considered for spinal cord injured patients with
which of the following?
A) High cervical cord injury with poor cardiopulmonary reserve
B) As a substitute for prophylaxis in a complete injury
C) Older than 70 years
D) All of the above

12. Which of the following is a true statement regarding women with spinal cord injury (SCI)
and pregnancy?
A) The likelihood of pregnancy is reduced since amenorrhea is common
B) The risk of complications during pregnancy is equivalent to that in the able bodied
population
C) A caesarian section is the preferred method of delivery
D) Autonomic dysreflexia may be the only presentation of labor in injuries above the T6
level

13. In the treatment of erectile dysfunction in spinal cord injured males, the physiatrist should
discuss which of the following options?
A) Phosphodiesterase type 5 inhibitors
B) Intracavernosal injections
C) Vacuum devices
D) All of the above

14. What level spinal cord injury leads one to be concerned about the risk of developing
autonomic dysreflexia?
A) T4 and above
B) T6 and above
C) T8 and above
D) T10 and above

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15. What is the most common cause of autonomic dysreflexia?

A) Pressure ulcers
B) Fractures or other trauma
C) Restrictive clothing
D) Bladder distention

16. A T4 American Spinal Injury Association (ASIA) C individual in your office begins to
get flushed. You check the individual’s blood pressure and find that it is elevated with a
decreased pulse. What should you do next?
A) Sit the person up and loosen any clothing
B) Catheterize the individual
C) Perform fecal disimpaction
D) Administer nifedipine

17. Which of the following statements is true regarding prognosis and spinal cord injury
(SCI)?
A) Preserved sacral sensation has a better prognosis for lower extremity recovery
B) Individuals older than 50 years have a better prognosis for recovery
C) A sensory incomplete injury has a less than 10% chance for ambulation
D) Muscles with antigravity strength can recover two grades in the first year

18. Which of the following individuals with spinal cord injury (SCI) can transfer on level
surface without the use of a board?
A) C4
B) C5
C) C6
D) C7

19. Which of the following is a risk factor for developing depression post-spinal cord injury
(SCI)?
A) Male gender
B) Age of onset above 40
C) Prior history of depression
D) Supportive social structure

20. In a patient with a spinal cord injury, which of the following is not an effective evacuation
technique in a bowel program?
A) Push-ups
B) Abdominal massage
C) Supine position
D) Deep breathing exercises

21. In a spinal cord injured (SCI) patient, which of the following is not true when establishing
a bowel program?
A) Schedule a routine the same time of the day after a meal
B) In areflexic bowel, the goal is firm-formed stool that can be manually evacuated
C) Fiber should be uniformly started in each patient
D) A mini-enema can trigger reflexic bowel by acting as mucosal stimulus

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22. What is the classification of a pressure ulcer with full thickness skin loss involving subcu-
taneous tissue and extending into but not through fascia?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV

23. In a patient with spinal cord injury (SCI), intermittent catheterization should be consid-
ered in which of the following?
A) Small bladder capacity (< 200 ml)
B) Cognitive impairment
C) Adequate hand function
D) Prone to autonomic dysreflexia

24. In a patient with spinal cord injury (SCI), suprapubic catheterization should be consid-
ered for which of the following?
A) Sacral pressure ulcer
B) Urethral abnormalities or obstruction
C) Improved body image
D) All of the above

25. In patients with spinal cord injury (SCI), what are the long-term complications of an
indwelling catheter?
A) Bladder and kidney stones
B) Hydronephrosis
C) Pyelonephritis
D) All of the above

26. Which statement is true regarding the use of alpha blockers in the treatment of detrusor
sphincter dyssynergia?
A) Urethral resistance is increased with the use of alpha blockers
B) Phosphodiesterase inhibitors should be used with caution in patients on alpha
blockers
C) Alpha blockers should be taken in the morning in the upright position
D) All of the above

27. The external urethral sphincter is innervated by the:

A) Hypogastric nerve
B) Pelvic nerve
C) Vagus nerve
D) Pudendal nerve

28. What is the most common location of heterotopic ossification (HO) in spinal cord injury
(SCI) patients?
A) Hip
B) Knee
C) Shoulder
D) Elbow

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29. Which of the following is a risk factor for the development of heterotopic ossification
(HO) in spinal cord injury (SCI)?
A) Gender
B) Level of lesion
C) Spasticity
D) Race

30. Which of the following is true of calcium metabolism in spinal cord injury (SCI)?
A) Hypercalcemia occurs more commonly in females, incomplete paraplegia, and chronic
injury
B) The risk of fractures is comparable to the able-bodied population
C) Passive weight-bearing (standing with the use of adaptive equipment) results in
improved bone mineral density
D) All of the above

31. The most caudal end of the spinal cord is at which level?
A) The 12th thoracic vertebra
B) The 10th thoracic vertebra
C) The 4th lumbar vertebra
D) The 2nd lumbar vertebra

32. How many cervical nerve roots are there?

A) 5
B) 6
C) 7
D) 8

33. The C6 nerve root exits:

A) Above the C5 vertebra
B) Above the C6 vertebra
C) Below the C7 vertebra
D) Above the C4 vertebra

34. Which of the following is the most common cause of traumatic spinal cord injury (SCI)?
A) Motor vehicle crash
B) Sports
C) Violence
D) Falls

35. What is the most common level of spinal cord injury (SCI)?
A) T10
B) T6
C) L5
D) C5

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36. The lateral spinothalamic tracts:

A) Control voluntary muscle activity
B) Transmit proprioception only
C) Transmit pain and temperature
D) Transmit proprioception, fine touch, and vibration

37. Which of the following is the most common cause of death for persons with a spinal cord
injury (SCI)?
A) Heart disease
B) Disease of the respiratory system
C) Cancer
D) Stroke

38. In the American Spinal Injury Association (ASIA) examination, the C5 myotome corre-
lates with what muscle group?
A) Elbow extensors
B) Finger abductors
C) Wrist extensors
D) Elbow Flexors

39. In the American Spinal Injury Association (ASIA) examination, the C7 myotome corre-
lates with what muscle group?
A) Elbow flexors
B) Long finger flexors
C) Elbow extensors
D) Wrist extensors

40. In the American Spinal Injury Association (ASIA) examination, the nipple line is the key
dermatome for what level?
A) T4
B) T10
C) T6
D) L4

41. In the American Spinal Injury Association (ASIA) examination, the umbilicus is the key
dermatome for what level?
A) T6
B) T4
C) T10
D) L4

42. A complete spinal cord injury is defined as:

A) A transection of the spinal cord
B) No motor or sensory function preserved in the sacral segments S4–5
C) No motor sparing, but sensory sparing below the level of injury
D) Strength less than antigravity below the level of injury

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43. What is the motor level of injury for this individual?

A) C6
B) T1
C) L3
D) C7

44. A patient sustains a spinal cord injury. He has the following motor examination:
C5—5/5 bilateral
C6—5/5 bilateral
C7—3/5 bilateral
C8—2/5 bilateral
T1—2/5 bilateral
L1—1/5 bilateral
L2—1/5 bilateral
L3—1/5 bilateral
L4—0/5 bilateral
L5—0/5 bilateral
Sensation—Intact to pinprick and light touch to the armpit; impaired (1/2) from armpit to
rectum with pinprick and light touch sparing at S4–5 and rectal tone.
What is the sensory level of injury?
A) T1
B) T4
C) S5
D) C7

45. A patient sustains a spinal cord injury. He has the following motor examination:
C5—5/5 bilateral
C6—5/5 bilateral
C7—3/5 bilateral
C8—2/5 bilateral
T1—2/5 bilateral
L1—1/5 bilateral
L2—1/5 bilateral
L3—1/5 bilateral
L4—0/5 bilateral
L5—0/5 bilateral
Sensation—Intact to pinprick and light touch to the armpit; impaired (1/2) from armpit to
rectum with pinprick and light touch sparing at S4–5 and rectal tone.
What is the American Spinal Injury Association (ASIA) Classification for this patient?
A) ASIA A
B) ASIA B
C) ASIA C
D) ASIA D

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46. An 82-year-old man trips and falls. On presentation, he has an ecchymosis on his chin. On
physical examination, bilateral upper extremities were found to have 2/5 strength with
elbow flexion and wrist extension, 3/5 strength with elbow extension, finger flexion, and
finger abduction, and 4/5 strength in bilateral lower extremities. He has intact sensation.
What is this spinal cord injury (SCI) syndrome?
A) Brown-Séquard
B) Central cord
C) Anterior cord
D) Cauda equina

47. A 17-year-old female is stabbed in the back and presents as follows:

Loss of sensation, paralysis, and loss of vibration below T5 on the left; loss of pain and
temperature below T5 on the right. What syndrome does she have?
A) Brown-Séquard
B) Central cord
C) Anterior cord
D) Cauda equina

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